In the medical industry, there is often a need for a laboratory technician, e.g., a cytotechnologist, to review a cytological specimen for the presence of specified cell types. For example, there is presently a need to review a cervico-vaginal Papanicolaou (Pap) smear slides for the presence of malignant or pre-malignant cells. Since its introduction over fifty years ago, Pap smears have been a powerful tool for detecting cancerous and precancerous cervical lesions. During that time, the Pap smear has been credited with reducing mortality from cervical cancer by as much as 70%. This once precipitous drop in the death rate has slowed however, and the mortality rate in the United States for this preventable disease has remained virtually constant, at about 5,000 per year since the mid-eighties. Therefore, about one-third of the 15,000 women diagnosed with cervical cancer annually still die, because the cancer was detected too late. A further cause for concern is National Cancer Institute data that shows an annual 3% increase in the incidence of invasive cervical cancer in white women under 50 years of age since 1986.
A number of factors may be contributing to this current threshold, not the least of which is the fact that many women, particularly in high risk populations, are still not participating in routine cervical cancer screening. Another contributing factor that has received much attention is the limitation of the traditional Pap smear method itself.
The reliability and efficacy of a cervical screening method is measured by its ability to diagnose precancerous lesions (sensitivity) while at the same time avoiding false positive diagnosis (specificity). In turn, these criteria are dependent on the accuracy of the cytological interpretation. The conventional Pap smear has false negative rates ranging from 10-50%. This is due in large part to the vast number of cells and objects (typically as many as 100,000 to 200,000) that must be reviewed by a technician to determine the possible existence of a small number of malignant or pre-malignant cells. Thus, Pap smear tests, as well as other tests requiring detailed review of biological material, have suffered from a high false negative rate due to fatigue imposed on the technician.
To facilitate this review process, automated systems have been developed to focus the technician's attention on the most pertinent cells, with a potential to discard the remaining cells from further review. A typical automated system includes an imager and an automated optical microscope. Briefly, the imager can be operated to provide a series of numerous images of a cytological specimen slide, each depicting a different portion of the slide. The imager then processes these images to determine the most pertinent biological objects for review on the slide, and their locations (x-y coordinates) on the slide. This information is then passed onto the microscope, which automatically proceeds to the x-y coordinates and centers on the biological objects for review by the technician. During this review process, the microscope will sequentially step through the x-y coordinates of the biological objects, placing the biological object within the center of its field of view. For example, if the number of pertinent biological objects to be reviewed equals 22, the technician will review 22 regions on the slide as the microscope automatically or semi-automatically moves the field of view to the defined x-y coordinates of the biological objects. The technician can then mark any objects on the slide that he or she believe require further review by a pathologist, for example, any objects having attributes consistent with malignant or pre-malignant cells.
In general, this automated procedure has proved to be successful, since the technician's attention is focused on a limited number of objects, obviating the need for the technician to review the vast number of objects (biological or not) on the specimen. Because the technician must typically review hundreds of slides per day, however, and thus, tens of thousands of biological objects, the technician may still be subjected to fatigue. In addition, there is also a commercial aspect that must be taken into account. The cost borne by laboratories to review cytological specimens, such as Pap smear specimens, is tied, at least in part, to the time taken for a technician to review each slide. That is, the more time it takes for a technician to review a slide, the more cost in labor the laboratory incurs. Conversely, the less time that it takes for a technician to review a slide, the more money the laboratory can save.